Endocrinology - canine Flashcards
ACTH stim testing - when can a 1ug/kg dose be used for testing or monitoring hyperA?
Dogs receiving mitotaine or trilostane treatment
Aldridge JVIM 2016
ACTH stim testing - when should a 1ug/kg dose not be used for testing or monitoring hyperA? why?
Dogs being tested for diagnosis of hyperA using ACTH stim test.
23% difference in interpretation of results between 5ug/kg and 1ug/kg doses
Aldridge JVIM 2016
LDDST for hyperA diagnosis- what is the: Sens? Spec? PPV? NPV?
Sens 96.6
Spec 67.2
PPV 73.1
NPV 95.6
Bennaim JVIM 2017
What LDDST pattern has the highest PPV for HyperA diagnosis?
And the lowest?
Lack of suppression - 93.9
Partial suppression - 67.9
escape/inverse - 36.8
Bennaim JVIM 2017
Does perivascular administration of corticotropin impact the outcome of ACTH stim testing for monitoring treatment with trilostane of dogs with hyperA?
no
no significant difference in pre or post ACTH cortisol if given IV or perivascular
Johnson JVIM 2017
What is the index of individuality (IoI)?
What does a low IoI mean?
reflects the relationship between the within and between-individual variable for that parameter.
low IoI meands low within individual variability in comparison withits between individual variability.
Tests with low IoI are not well suited to pop-based reference intervals because the individual’s homeostatic set point covers only a small fraction of the populations reference interval. thus a test resul that is outside of the individuals homeostatic set point but within the pop reference interval would be falsely considered normal.
Gal JVIM 2017
What is the IoI of post ACTH stim cortisol in healthy dogs?
and the CD?
What does this mean?
IoI = 1.1 CD = 3.3 ug/dL (92 nmol/L)
This represents intermediate individuality.
False negatives can occur with Hypercortisolism when cortisol is outside of the individuals homeostatic set point but within the reference interval
CD should be >3.3 ug/dL (92nmol/L) to assure that the difference between sequential measurements is not due to biological or analytical variability.
Gal JVIM 2017
What is CD?
Critical difference betweeen sequential measurements of a test parameters is the difference not due to the components of biological or analysitcical variability. .
assists in telling whether the sequential test results are significantly different or if the difference is due to total variability in the test.
Gal JVIM 2017
Is there a difference in adrenal size between dogs with pituitary HyperA and dogs with atypical hyperA?
No
PDH - 6.4
Atypical 7.2
normal 5.3mm
Frank JVIM 2015
What is atypical hyperA?
Clinical signs of hyper cortisolaemia with not evidence of sex-hormone secreting adrenal tumour and hyperA screening test results wnl.
Suspected due to elevations in precursor hormones.
Frank JVIM 2015
What can increase 17-hydroxyprogesterone?
- atypical hyperA
- non adrenal neoplasia
- estrus, diestrus and pregnancy
Frank JVIM 2015
Is there a difference in hourly or sum cortisol concentrations between dogs with PDH and atypical HyperA?
hourly - different
PDH = 4.3, atypical = 2.9 control + 1.4
sum - no difference
Frank JVIM 2015
What is the MST for dogs post transsphenoidal hypophysectomy in dogs with PDH?
781 days
van rijn JVIM 2016
what is the 4 week post op survival for dogs post transsphenoidal hypophysectomy for PDH?
what % have remission confirmed?
91% alive
92% of these in remission
van rijn JVIM 2016
What % of dogs undergoing post transsphenoidal hypophysectomy for PDH management develop recurrence? What is the median time for this?
27%
median 555 days.
van rijn JVIM 2016
What differences do dogs that had recurrence of signs of hypercortisolaemia post transsphenoidal hypophysectomy from those without recurrence?
why are these important?
higher pituitary height/brain area ratio
higher pre-op basal urinary corticoid to creatinine ratio (UCCR)
Larger have less favourable outcomes.
survival time and disease free fractions negatively correlated with pituitary gland size as assess by pit height/brain area ratio.
van rijn JVIM 2016
what differences are there in dogs with PDH between those that have GB mucocoels and those that don’t?
- more severe clinical signs
- higher total cholesterol
- higer post ACTH stim cortisol at time of diagnosis
- <6kg more likely to have cholestatic disease
- req higher dose of trilostane for both GBM (2.5 x higher) and cholestasis (1.5 x higher)
likely associated with
- lipid soluable/hydrophobic characteristics of trilostane
- breed, genetic, female => cholesterol metabolism and bile secretion differences
Kim JVIM 2017
is there a significant benefit to checking pre-ACTH stim cortisol in dogs with PDH?
No
pre-ACTH cortisol failed to discriminate between PDH and non-adrenal illness.
Nivy JVIM 2018
Using what cut offs, is the sens and spec for ACTH stim in diagnosing PDH?
for diagnosis of PDH:
Cut off - 683 nmol/L (24.8ug/dL)
Sens 86%
spec 94%
Cut off - 718 nmol/L (26.0 ug/dL)
Sens 81%
Spec 100%
Nivy JVIM 2018
When are peak levels of melotonin?
when is SARDs more likely?
winter - shorter daylight hours.
Oh JVIM 2018
What is urine 6-sulfatoxymelatonin concentration and what dose it represent?
urine MT6 conc = accumulated amount of systemic melatonin over several hours and is less affected by fluctuations in circ concentrations
accounts for >70% of melatonin secreted.
conc in urine is 2-3 times greater than urine melatonin.
Oh JVIM 2018
Are there any hormonal differences betweeen dogs with PDH and SARDs?
Urine MT6 is higher in dogs with PDH (4.08) compared to dogs with SARDS (2.37)
no difference in melatonin, serotonin or dopamine
Oh JVIM 2018
Is there a difference in measurement of ACTH stim tests in well controlled hyperA at 3-6h post trilostane vs 9-12h post trilostane?
what is the clinical significance of this?
Yes - lower in the 3-6h compared to 9-12h
Dogs with low 3-6h and clinically well controlled may have normal 9-12h post trilostane ACTH stim suggesting that they are actually clinically well controlled and no dose adjustment is needed.
if concerned that has iatrogenic hypoA, can check 9-12h post trilostane to see if is elevated, supporting ongoing treatment.
Midence JVIM 2015
What is the MST in dog with untreated hyperA from diagnosis?
506 days.
Nagata JVIM 2017
What proportion of dogs have concurrent pituitary and adrenal lesions with hypercortisolism?
5%
von Bokhorst JVIM 2018
What proportion of dogs have concurrent pituitary and adrenal lesions with hypercortisolism and dexamethasone resistant?
10%
von Bokhorst JVIM 2018
What proportion of dogs with hyperA is pituitary dependant?
what proportion of these dogs have pituitary gland enlargement?
80-85%
70% have pituitary gland enlargement
von Bokhorst JVIM 2018
What proportion of dogs with hyperA is adrenal dependant?
15%
von Bokhorst JVIM 2018
What is assessed in teh Cushings QoL questionnaire (CushQoL-pet)?
Clinical impact:
- thirst
- urination in house
- hunger
- panting
Demenour
- Depressed and quiet
- No energy
- reduced interaction
- reduced play
- Disoreinted/confused
physical impact
- weight gain
- Coat
- Skin
- Physical condition/pot belly
- struggle to walk
Owner impacts
- Negative comments about appearance
- concern about future of dog
- routine disruption
- struggling to manage
- human animal bond
Schofiled JVIM 2019
What are phaeochromocytoma? from which cells?
Catecholamine producing tumour of the chromaffin cells of the adrenal medulla.
Salesov JVIM 2015
How are phaeochromocytomas diagnosed?
- clinical suspicion
- adrenal mass
- increased plasma and urine concentration of catecholamine metabolites
- histopath
Salesov JVIM 2015
Which test is superior for the diagnosis of phaeochromocytoma?
Urinary normetanephine : creatinine
- has no overlap with hyperA or normal dogs
Plasma normetanephine did have some overlap but was still suitable.
Salesov JVIM 2015o
How is the phosphadiylinositol 3 kindase (PI3K) signalling pathway a possible target for canine cortisol secreting tumours?
initiated by tyroskine kinases like IGF type 1 or dimers of epidemal growth factor and counteracted by PI3K inhibitor phosphatase and tensin homolog.
Activation of PI3K => p-AKT => stim cell proligeration, survival and growth.
in humans adenocortical carcinomas over express IGF receptor and IGF-II gene but adenomas don’t.
Kool JVIM 2015
What receptors like with PI3K pathway are increased with canine adrenocortical carcinomas?
ERBB2 (erythroblastic leukaemia viral oncogene homolog part of the epidermal growth factor receptor family. - possible therapeutic target for carcinoma
Higher expression of inibitor of differentiation 1 & 2 (ID1, ID2) - possible prognostic/therapeutic target.
Kool JVIM 2015
What gene codes for the production of steriodogenesis by the adrenals? and what does it express
CYP11B gene => CYP17 expression in zona glom and zona fasciculata. (zone specific)
Sanders JVIM 2016
Where is CYP17 expressed and why is this important?
Expressed by zone specific (glomerulosa and fasiculata).
Zone specific => in zona fasiculata produces cortisol while lack of CYP17 in zona glom => restricts steroidogenesis to just mineralocorticoirds
thus possible target for selective inhibition of cortisol without affecting aldosterone synthesis
Sanders JVIM 2016
What difference in ACTH stimulation technique is required when using the depot vs short acting forumulations of synthetic ACTH? when is the peak cortisol with the depot?
Depot:
Peak cortisol at 2-4hs.
For hyperA - test at 0 and 3h post injection
For hypoA - test at 0 and 1h post. no change from baseline
Sieber-Ruckstuhl JVIM 2015
How long does the depot injection of synthetic ACTH last?
24h
Sieber-Ruckstuhl JVIM 2015
What basal cortisol cut off can be used to exclude hypoadrenocorticism. What is the sensitivity of this?
< or = 55nmol/L
sensitivity 99.4%
Sieber-Ruckstuhl JVIM 2015
What cut offs are available to assess basal cortisol for detection of hypoadrenocorticism? what are their sensitivity, specificity and PPV?
< or = 55nmol/L is sensitive 99.4% for hypoadrenocorticism and 67% specific. Thus conc > 55 are used for to exclude the diagnosis.
<5.5nmol/L is 79.5% sens and 99.1 Spec for hypoA.
or = 22nmol/L sens 96.9%, spec 95.7%
Sieber-Ruckstuhl JVIM 2015
Does abnormal vs normal electrolytes affect the diagnosis of hypoA based on basal cortisol?
No
Sieber-Ruckstuhl JVIM 2015
What is the lowest dose rate of cosyntrophin that can be used to diagnose hypoA?
1 ug/kg
how do you calculate an individualized dosing plan for DOCP for treatment of hypoA in a newly diagnosed dog?
commence at 2.1-2.6mg/kg
- measure plasma sodium and postassium concentrations weekly starting from day 25-30 post DOCP
- when clinically abnormal or abnroaml sodium or potassium levels were noted, subtract 7 days fro the number of days from last dose to give individual dosing interval.
Jaffey JVIM 2017
what is the median drug cost reduction that can occur with individual dosing interval of DOCP?
57.5%
Jaffey JVIM 2017
what is the median dosing interval for individualised dosing intervals with DOCP?
58 days (38-90)
Jaffey JVIM 2017
what is Schmidt’s syndrome?
increase in TSH in untreated hypoA
Reusch JVIM 2017
Should you treat dogs with elevated TSH and untreated hypoA for hypothyriodism?
No. will normalise TSH with treatment of hypoA/glucocorticoids within 4 months.
Reusch JVIM 2017
what may increased cTSH in a dog with weakness suggest further testing for?
hypoA
Reusch JVIM 2017
What is the lower starting dose for DOCP (zycortal) ?
Which dogs are likely to need more than this?
1.5 mg/kg DOCP SC q28-30 days
young dogs less than 3 years old are likely to need higher doses but this may be able to be reduced over time.
sieber-ruskstuhl JVIM 2018
What is the recommended protocol for lower dose DOCP (zycortal)
Dose at 1.5mg/kg sc
check elytes on days 14 and 28
Day 14:
K+ below RR and Na + within RR =>decrease dosage by 5-10%
Day 28:
K+ <4.3 - next injection postponed with weekly check until it was within the reference interval and dosage reduced by 5-10% for every week of delayed dosage.
Aim for dosing at 28-30 days with elytes within RR at this stage.
sieber-ruskstuhl JVIM 2018
What is CAR testing?
Cortisol to ACTH ratio to diagnose hypoA without having to use synthetic ACTH
Boretti JVIM 2015
what is Cortisol to ACTH ratio (CAR) used for?
Using what cut off, what is the sensitivity and specificity?
CAR > 0.01
sens 100%
spec 99%
Boretti JVIM 2015
What are the limitations of CAR testing?
- overlap between hypoA dogs and those with hypoA mimicing diseases so misdiagnosis is still possible
- unclear on efficacy in dogs with secondary hypoA.
Boretti JVIM 2015
Which dogs in sweden are at higher risk of developing HypoA?
- Portugese water dogs
- Standard poodle
- bearded collie
- Cairn terrier
- Cocker spaniel
- female dogs.
Hanson JVIM 2016
What is the overall incidence of hypoA in dogs in sweden?
2.3 cases per 10,000 dog -years at risk.
Hanson JVIM 2016
How does ketoconazole cause iatrogenic hypoA?
inhibits cytochrome P450 enz and the cholesterol side chain cleavage complex 17,20-lyase, 11B-hydroxylase and 17a-hydroxylase => inhib steroidogenesis.
Hernandex-bures JVIM 2018
Is ketoconazole induced adrenal insufficiency permanent?
No. test with ACTH stim
Hernandex-bures JVIM 2018
Does ketoconazole induced adrenal insufficiency cause mineralocortioid insufficiency?
No - only steroidogenesis is affected.
Hernandex-bures JVIM 2018
What is the accuracy of Freestyle libra compared to plasma glucose at:
- low
- normal
- high blood glucose concentrations?
Accuracy:
- low 93%
- normal 99%
- high 99%
Corradini JVIM 2016
At low blood glucose ranges, is the freestyle libra more likely to over or under estimate blood glucose?
under-estimate 69% of the time
Corradini JVIM 2016
At normal blood glucose ranges, is the freestyle libra more likely to over or under estimate blood glucose?
over-estimate 54% of the time
Corradini JVIM 2016
At high blood glucose ranges, is the freestyle libra more likely to over or under estimate blood glucose?
over estimate 59% of the time
Corradini JVIM 2016
Is diabetes in labradors likely secondary to genetic related obesity?
No
Davdison JVIM2017
What is the POMC gene mutation associated with and in what breed?
Increased appetite and obesity in labradors
Davdison JVIM2017
True or false:
The POMC gene mutation is associated with increased risk of Diabetes mellitus in labradors?
False
Davdison JVIM2017
What lipoproteins are increased in dogs with diabetes mellitus compared to healthy?
triglycerides
High density lipoprotein cholesterol
very low density lipoprotein - cholesterol
low density lipoprotein - cholesterol
non high density lipoprotein - cholesterol
apolipoprotein B100
Seage JVIM 2018
Dyslipidaemia of dogs with diabetes mellitus is characterized by pronounced increases in which lipoproteins?
low density lipoprotein - cholesterol
non high density lipoprotein - cholesterol
Seage JVIM 2018
In humans with DM there is a correlation between ApoB and non HDL-C. Is this the same in dogs?
What is the significance of these in people?
yes
increased risk of cardiovascular disease in people
Seage JVIM 2018
What is Apo-B?
Apoliproprotein B is a large protein molecure that carries LDL lipds and is of increasing interest because the number rather than the concentration of LDL may be associated with increased risk of cardiovascular disease in people.
Seage JVIM 2018
what is the heritability of DM in American eskimo dogs?
0.62 (high)
Cai JVIM 2019
Is the inheritance of DM in american eskimo dogs associated with a single or multiple genes?
Polygenic, non-mendalian
Cai JVIM 2019
what gender and neuter status are at higher risk of DM in american eskimo dogs?
neutered females > neutered males >»_space;intact males> intact females.
Cai JVIM 2019
What is CECS? What else is it known as?
Canine epileptoid cramping syndrome - a paroxysmal movement disorder of border terriers similar to nonkinesigenic dyskinesis in humans.
Paroxysmal Gluten - sensitive Dyskinesia
Lowrie JVIM 2015
Lowrie JVIM 2018
What breed is CECS/PGSD it seen in? from what age?
border terriers from 6 weeks to 7 years
Lowrie JVIM 2015
Lowrie JVIM 2018
CECS/PGSD - what are the clinical signs?
What are the neuro findings?
- attacks of involuntary movement including
- dystonia (involuntary contraction with repetitive or twisting movements)
- tremor,
- ballism (flailing proximal limb movements)
- athetosis (involuntary writhing movements)
- chorea (involuntary, irregular, unpredictable muscle movements - figgety, restless, dancing)
at rest with no loss of conciousness. can prevent functional movement of limbs. - paroxisms in response to stress/excitement affect extremeties, head and often have borborygmi.
- often have mild GI sigsn V+. D+, borborygmi-
- often have dermopathy
no brain/csf findings and normal between.
Lowrie JVIM 2015
Lowrie JVIM 2018
What is thought to trigger CECS/PGSD?
Gluten
Lowrie JVIM 2015
Lowrie JVIM 2018
What tests can be performed to diagnose CECS/PGSD?
antitransglutaminase 2 antibodies (TG2 IgA)
antigliadin antibodies (AGA IgG)
Gluten free diet response
Abs high specificity bt low sensitivity.
Lowrie JVIM 2015
Lowrie JVIM 2018
What is the treatment for CECS/PGSD?
Gluten free diet.
Lowrie JVIM 2015
Lowrie JVIM 2018
Do border terriers with epilpesy have increased TG2 IgA and AGA IgG?
rarely.
When shoudl border terriers be tested for TG2 and AGA antibodies?
If have clinical signs suggestive of GIT, dermatological +/- neurological signs of PGSD.
Lowrie JVIM 2018
What is homocysteine?
when dose hyperhomocystinemia occur?
Homocystine - a sulfated intermidate AA that is synth from dietary methionine and then remethylated to methionine or metabolised to cytine. Req B6, B9 and B12.
Occurs when there is a lack of intracellular
- B6 (pyridoxine),
- B9 (folic acid) and/or
- B12 (cobalamin)
Helimann JVIM 2017
what clinical effects has hyperhomocystineamia been associated with?
cardiovascular disease
thrombotic disease
diarrhoea
normal greyhounds
Helimann JVIM 2017
What other laboratory abnormalities are noted with hyperhomocystineamia?
low folate
low B12
low globulins but normal albumin
Helimann JVIM 2017
What is Bezafibrate?
a lipid reducing drug that is a derivative of fibric acid
Marco JVIM 2017
How do fibrates work?
mediated by peroxisome proliferateor-activated receptor (PPAR) A =>
- induction of hepatic fatty acid update
- decreased hepatic triglyceriate and VLDL synthesis
- increased expression of liporotrin lipase
- increased gall bladder excretion of hepatic cholesteriol
- increased production of HDL.
Thus decrease production and increase excretion => reduced circulating triglycerides and cholesterol concentration.
Marco JVIM 2017
Is bezafibrate useful to reduce hyperlipidaemia?
What proportion of dogs will see a reduction?
91% returned to normal for both primary and secondary hyperlipidaemia within 30 days.
greater reduction in primary hyperlipidaemia groups.
Marco JVIM 2017
is hypertriglyceridemia associated proteinuria commonly associated with azotemia or hypoalbuminaemia?
What breed is it most common in?
no
geriatric minature schnauzers
Smith JVIm 2017
in regards to minature schnauzers with idiopathic hyperlipidaemia which of the following is correct (more than 1 answer possible)?
- hypertriglycerisaemia and hypercholesterolaemia were independantly associated with:
- increased calprotectin
- increased S100A12 - had higher calprotectin concentrations with :
- increased triglycerides
- hypercholesterolaemia
- both
3. ultralow fat diets reduced: f- triglycerides - cholesterol - calprotecin - S100A12
- Increase TGs and Cholesterol were associated with increased calprotectin but not S100A2
- Higher calprotecin was correlated with increased triglycerides and both, but not cholesterol on its own
- Ultralow fat diets reduced triglycerides and cholesterol but not calprotecin or S100A12.
Helimann 2018
dogs with hypercalcaemia secondary to primary hyperparathyroidism are likely to have post op hypocalcaemia when the pre op iCa++ is above what?
if the pre-op iCa++ is >1.75mmol/L
Dear JVIm 2017
Is there evidence for the prophylactic use of calcitriol in dogs with primary hyperparathyroidism pre-op?
No - no difference in post op iCa++ found byt armstrong et al JVIM 2018
Is there downregulation of Vit D receptors in the intestine in dogs with inflammed small intestines?
no
Cartwright JVIM 2018
Where are Vitamin D receptors expressed in the dog?
high in:
- kidney
- duodenum
- skin
- ileum
- slpeen
weak in:
- colon,
- heart
- LN
- liver
- lung
- ovary
Not in
- stomach
- testes
Cartwright JVIM 2018
Patients with what types of cancer can have alterations to 25 (OH)D concentrations? (25-hydroxyvitamin D = calcidiol)
What are these changes likely secondary to/mediated by?
MCT, lymphoma osteosarc
plasma iCa++
increased iCa++ => increased 25hydroxyvitamin D
decreased iCa++ => decreased 25hydroxyviamin D
What changes in Vitamin D and its metabolites would be expected in sled dogs during exercise?
Is there any change in CRP in these dogs?
What does this suggest?
increased 25(OH)D3 on day 2 and 8 of the race increased 24,25(OH)D3 on day 8 of the race no change with 1,25(OH)D3 at any time point.
CRP increased from day 2.
increased 24,25(OH)D3 suggests metabolic variations in dogs that lead to enhanced disposal of Vitamin D.
Increased Vit D3 suggests that acute inflam phase response is unlikely to decrease Vit D3 as prev thought.
Spoo JVIM 2015
What are potential causes of hypoparathryoidism in dogs?
- Primary/idiopathic/immune med
- Absence/destruction of parathryoid glands
- thyroidectomy
- neck durgery
- severe soft tissue injury
- radiation damage - Mg deficiency/excess
- Sudden reversal of chronic hypercalcaemia
- tumour lysis/removal
- parathyroidectomry (fo treatment of hyperparathyroidism)
? transient/self limiting secondary critical illness/pyrexia
- other causes reported in humans only.
- drug induced - Lasp, doxo, cytosine arabomindie, cimetadine aluminium, ethanol
- genetic/hereditary agenesis
- deposition of miners eg copper in Wilson’s syndrome or iron in haemochromatosis
Warland JVIM 2015
What drugs have been used to treat suspected immune mediated hypoparathryoidism?
pred
cyclosporine
Warland JVIM 2015
what is the mechanism of action of cyclosporine?
Inhibit T-cells vis inhibition of calcineurin preventing activation of T-helper and relsease of IL-2 thus reducing clonal expansion of Tcells.
Warland JVIM 2015
Comparing chemiluminescent vs ED for the assessment of FT4 in hypothyroid dogs, positive for thyroglobulin antibody, what is the major concern between these two methods?
Poor sensitivity. 75% for veterinary FT4
Increased risk of false negative results (25-38% of dogs with TGA-positive may be misclassified as non-hypothryoids by chemiluminescence.
Randolph JVIM 2015
What are potential causes of adult onset central hypothyroidism?
Tumour in pituitary or adjacent regions
- lymphocytic adenohypophysitis
- head trauma
- non-traumatic intracranial hemorrhage
- hypophysectomy
Annemarie JVIM 2016
What breed can central hypothryoidism be seen in?
Miniature schnauzers
Annemarie JVIM 2016
what are the clinical features associated with congenital hypothyroidism?
- disproprtionate dwarfism: short broad skull, short mendible, enlarged craniaum, short limbs
kyphosis - mental dullness, weakness, gait abnormalities
- inappetance, constipation, delayed dental eruptions
- alopecia or persistent puppy coat, dry hair, thick skin
- dysponea
Goitre - if hypothalamic-pituitary axis is intact and increased production of TSH => goitre.
if hypothalamic-pituitary axis is not intact eg pituitary TSH deficiency => no goitre.
Feldman
what are the difference in normal, non-thyroidal illness, primary, secondary and tertiary hypothryoidism in dogs seen with TT4, FT4, TSH, TRH, TSH stim, TRH stim hormone assays and scintigraphy?
Normal:
- TT4: within RR
- FT4: within RR
- TSH: within RR
- TRH: within RR
- Scintigraphy: 1:1 thyroid to parotid salivary gland uptake. symmetical. Approx 1% uptake
Non-thyroidal illness:
- TT4 - low
- FT4 - normal
- TSH - low
- Scintigraphy - normal uptake with 0.39-1.86% uptake
- TSH stim- low pre, normal post
Primary:
- TT4: low
- FT4: low
- TSH: increased
- TRH: increased
- Scintigraphy: low/undetactable uptake. 0.03-0.26% uptake. may be smaller than usual
- TSH stim: both pre and post will be low
Primary with thyroglobulin antibiodies:
- TT4: normal - increased
- FT4: low to normal
- TSH: increased
- TRH: increased
- Scintigraphy: normal to increased (false positive)
- TGAA: increased
Secondary:
- TT4: low
- FT4: low
- TSH: low
- TRH: high
- Scintigraphy: reduced uptake, may be smaller.
- TSH stim: reduced T4 pre, increased T4 post.
- TRH stim: reduced TSH pre and post
Tertiary:
- TT4: low
- FT4: low
- TSH: low but increases after administration of TRH
- TRH: high
- Scintigraphy: unknown.
- TSH stim test - reduced T4 pre, increase TT4 post
- TRH stim test - reduced TSH pre, increased TSH post
Feldman
what is the sensitivity and specificity of: - TT4 - FT4 - TSH - TGAA in dogs?
- TT4:
- sens 89-100%
- spec 73-82% - FT4
- sens 80-98%
- spec 78-94% - TSH
- sens 58-87%
- spec 82-100% - TGAA
- sens 91-100%
- spec 94-100%
Ettinger
in healthy euthyroid dogs, how long after discontinuation of levothyroxine therapy should you wait before testingT4, fT4 and TSH to minimize the effects of the previously therapy?
1 week
Ziglioli JVIM 2017
in dogs with hypothyroidism what changes may be expected with total homocystine and folic acid.
increased homocystine and decreased folic acid.
in sick dos, total homocystine was inversely correlated with folic acid.
Golynski JVIM 2017
What methods can be used to differential primary hypothyroidism and non-thyroidal illness?
T4 and TSH
Primary: low T4, increased TSH
NTI: low T4, los TSH
TSH Stim/respnse test:
Primary: pre and post both low
NTI: Pre low, post normal
Scintigraphy:
Primary: low/undetactable uptake. 0.03-0.26% uptake. may be smaller than usual
NTI: normal uptake with 0.39-1.86% uptake
Growth Hormone + TRH stim:
Primary:higher (3.2ug/l) and increased after TRH stim
NTI: lower (0.73ug/l) and did not change after TRH stim
TRH Stim:
Primary: no change in TSH from baseline
NTI: TSH increased from baseline.
Pijnacker JVIM 2017
Why might hypothyroidism cause increased growth hormone?
- direct edddects on transcription ofn GH gene
- Stomatostatin = inhibitor of GH and TSH release.
low T4 => reduced stomatostatin to increase TSH and secondarily increase GH.
Pijnacker JVIM 2017
What impacts does hypothyroidism have on the heart measured by ECG and echo?
- decreased HR
- decreased P wave amplitude
- Decreased R wave amplitude
- decreased EPSSn
- decreased Transmitral E wave velocity (Emax)
Guglielmini JVIM 2019
What ECG and echo changes are seen in dogs with hypothyroidism treated with thyroxine supplementation for 60 days?
- increased HR
- increased P-wave amplitude
- increased fractional shortening
- increased Emax
- reduced LV end diastolic volume index
- normal systolic diameter
- normal EPSS
Guglielmini JVIM 2019
Are cardiac changes associated with hypothyroidism permanent?
No they are , mild, transient and reversible with thyroxine therapy
Guglielmini JVIM 2019
Does treatment of hypothyroidism create any change in the behaviour or neuro-hormonal status of dogs?
increases activity but does not change behaviour, serotonin or prolactin levels.
Hrovat JVIM 2018
Reduced Vitamin B12 causes an increase in which intracellular enzymes?
Homocystine
Methyl-malonic acid (MMA)
Kook JVIM 2018
What is Imerslun-grasbeck syndrome?
hereditary cobalamin malabsorption
Kook JVIM 2018
in what breeds is hereditary cobalamine malabsorption seen most often?
- Australian Shephers
- Beagles
- Border collies
- giant Scnauzers
Kook JVIM 2018
What genetic mutations are thought to cause hereditary cobalamin malabsorption?
- AMN (amnion less subunit) in Giant schnauzer and Australian shepherd
- CUBN (cubilin) gene in border collies and beagles.
both are function receptro complexes that coablamin binds to for uptake from the gut.
Kook JVIM 2018
what dose of daily cyanocobalamin is required to maintain appropriate B12 levels in dogs with hereditary cobalamin malabsorption?
1mg PO q24h
Kook JVIM 2018
Are macrocytic, non-regenerative anaemias common in dogs with cobalamin deficiency?
no - they can occur and are reported in humans but not in dogs, however increased MMA was an uncommon finding in the study group and dogs wtih anaemia frequently had low cobalamin and folate
Stanley JVIM 2018
What changes in serum cobalamin, folate, iron and HCT are expected in pregnancy and at what stages.
between mid to late pregnancy:
- cobalamin decreased
- folate, no change
- iron increased
- transferrin - increased
- HCT - decreased.
Nivy JVIM 2019
What factors in pregnant bitches can affect cobalamin levels?
- stage of pregnancy - lower in late pregnancy
- number of pups - each increase in littler size corresponds to 28pg/ml decreased in cobalamin.
Nivy JVIM 2019
What changes in serum and CSF hormonal and neurotransmitters are expected in obese beagles compared to normal?
- increased leptin
- reduced serotonin
- reduced adiponectin
Park JVIM 2015
What changes in the microbiome based on 16S rRNA sequencing are expected in obese beagles compared to healthy?
- reduced firmucutes
- increased gram negative proteoobacteria
- reduced diversity
Park JVIM 2015
in both healthy and obese dogs what order do the following increase after a meal?
- glucose
- triglycerides
- insulin and glucagon
- insulin and glucagon (1h)
- triglycerides (2hr)
- glucose (3hr)
Soder JVIM 2016
Is UCCR higher before or after a meal?
after
Soder JVIM 2016
what differences in glucose, triglycerides, insulin/glucagon and UCCR are noted between healthy and obese dogs pre and post pyrandially?
- glucose - both higher post but no diff between obese and lean
- triglcerides - both increase post but higher in obese
- insulin/glucagon - both increased post, but no difference between
- UCCR - both higher post with higher fasting UCCR in obese.
Soder JVIM 2016
What does an increased a higher post pyrandial triglyceride and high pre-pyrandial UCCR in obese dogs suggst?
They may be exhibiting early signs of metabolic imbalance
Soder JVIM 2016
What cardiac changes can be seen on echo in obese dogs compared with healthy?
- increased IV septal widgeth in diastole to LV internal dimension in diastole ration
- reduced ratio of pear early to peak late LV inflow velocites
- reduced ratio of peak realy to peak late mitral annual tissue velocities
- increased fractional shortening
- increased ejection fraction percentage.
Tropf JVIm 2017
What metabolic changes can be seen in obese dogs compared with healthy?
- Increased insulin:glucose ratio
- dyslipidaemia with increaed cholesterol, triglycerides and HDLP
- reduced adiponectin
Tropf JVIm 2017
What inflammatory changes may be seen in obese dogs compared to healthy?
- increased IL-8
- increased keratonocyte derived chemokine-like inflammatory cytokines.
Tropf JVIm 2017
Which dogs have the highest median:
- endothelin -1
- Renin
- cortisol
ET-1: newfoundlands
Renin: Dachshund
Cortisol: Finnish Lapphunds
Hoglund JVIM 2016
What is capromorelin?
A ghrelin receptor agonist
Ghrelin is released from endocrine cells in the stomach and stimulates appetite and food intake thus capromorelin improves appetite and body weight.
What proportion of brachycephalic dogs with BOAS had GIT signs?
What were the most common endoscopic abnormalities?
what did gastric histopath generally show?
76% had GIT signs
- most ocommon abnormalities were
- oesophageal deviation
- atony of teh cardia
- distal oesophagitis
- most common histopath change was chronic inflammation in the stomach.
Gianella JVIM 2019
What proprotion of brachycephalic dogs with BOAS had laryngeal collapse?
86%
Gianella JVIM 2019
What biochemical changes may be seen in brachycephalic dogs with BOAS? do these relate to clinical signs.?
Increased to variable extents:
- glucose
- fructosamine
- triglycerides
- cholesterol
- CRP
- pre beta, beta lipoproteins
- cholomicrons
Did not correlate with clinical signs
Gianella JVIM 2019
What is the median disease free interval for dogs undergoing hypophysectomy with corticotroph adenoma?
Proportion hat had recurrrence?
median disease free interval in those that had recurrence?
896 days median disease free period
28% recurrence
588 days median disease free period of those that had recurrence
van Rijn JVIM 2015
In dogs undergoing hypophysectomy for corticotroph adenoma, what variables are associated with a higher risk of recurrence?
- pituitary height/brain area ratio
Associated with a shorter disease free interval
- high ACTH 5 hours post surgery
- high cortisol 1 and 4h post surgery
- high normalized ACTH 3h post surgery
- high normalized cortisol 4h post surgery
- random slope of cortisol.
van Rijn JVIM 2015
What are possible causes of SIADH?
- hydrocephalus
- amebic mengioencephalitis
- immune med liver disease
- heartworm
idiopathic - vinblastine overdose
- anaesthetic
- aspiration pneumonia
humans
- pulmonary disease
- CNS disease eg traumatic brain injury and subarachnoide haemorrhage
- meds SSRI
neoplasia
- head and neck surgery esp primary brain tumour removal
Bowles JVIM 2015
Lispro insulin:
- when is the peak effect?
- what is the duration of action?
- what routes of administration can it be given?
- Can it be used for DKA management?
peak effect: 1-3 h
duration of action 3-6h
Sc/CRI
can be used as a CRI to manage DKA in cats.
plumbs
Malerba JFMS 2018
What is the main difference between lispro and regular insulin?
- rate of disassocaiteion and thus rate of absorption when given SC. Lispro is slower.
Malerba JFMS 2018
Regular insulin:
- when is the peak effect?
- what is the duration of action?
- what routes of administration can it be given?
- Can it be used for DKA management?
IV:
immediate onset
peak effect 0.5-2h
duration of action 1-4h
IM onset 10-30m peak effect 1-4h duration 4-10h IV/IM
Frequnetly used for DKA via CRI
plumbs
NPH - isophane insulin:
- when is the peak effect?
- what is the duration of action?
- what routes of administration can it be given?
- Can it be used for DKA management?
Sc only
onset 0.5-2h
peak 2-10h (d) or 2-8h (cat)
duration 6-18h (d) 4-12h (c)
not really for DKA
plumbs
Lente/porcine insulin zinc suspension/Caninsulin
- when is the peak effect?
- what is the duration of action?
- what routes of administration can it be given?
- Can it be used for DKA management?
Sc admin
- 2 peaks; 2-6h and then at 8-14h
duration of action - 14 to 24h
cats
sc
single peak 1.5-8h
duration of actoion 8-12h
plumbs
PZI (protamine zinc suspension)
- when is the peak effect?
- what is the duration of action?
SC dogs
onset 1-4h
peak 4-8h
duration 6-28h
SC cats
onset 0.5-1.5h
pea 4-9h
duration of effect 7-18h
Glargine
- when is the peak effect?
- what is the duration of action?
- what routes of administration can it be given?
no peak effect generally but dogs may have hypoglycaemia approx 2h after dosing lasting 12h
if given Im or IV rapid release. microprecipitatesonly form in the SC.
plumbs
Detemir
- when is the peak effect?
- what is the duration of action?
- what routes of administration can it be given?
SC - self associates and slowly absorbed prolong hypoglycaemic effect and no real peak generally but can.
onset 1.8h
peak 7h
duration 14h
plumbs
Degludec insulin/Tresiba:
- when is the peak effect?
- what is the duration of action?
- what routes of administration can it be given?
- Can it be used for DKA management?
Sc multihexamers at SC site => delay and prolonges absorption. onset 1.5h peak 5.5h duration 11h
plumbs
What cats are at higher risk of developing DM in Sweden?
Domesti cats Males burmese Russian Blue Forwegian Forest Cat Abyssinian
What diseases other than DM can cause an increase in beta hydroxybuturate in cats?
Does this cause ketonuria?
states of negative energy balance/catabolism or decreased glucose utilization.
- CKD 21% - mild increase
- HyperT4 20% - mild
- hepatic lipidosi 73% marked.
none had ketonuria
Gorman JVIM 2016
what factors may predict relapse of DM in cats?
Fasting glucose>= 7.5mmol/L
severely impared glucose tolerance >= 5h to return to <6.5mmol/L BG
BG> 14mmol/L at 3h
Gottlieb JVIm 2015
What proportion of diabetec cats in remission had:
- impaired fasting glucose concentration
- impaired glucose tolerance?
fasting - 195
tolerance 76%
Gottlieb JVIm 2015
What glucose variables should be considered as prediabetic in previously diabetic cats?
Cats that have:
- impaired fasting glucose concentration >7.5mmol/L
- impaired glucose tolerance testing with 3h glucose concentration > 14mmol/L
88% chance of relapse in next 9 months
Gottlieb JVIm 2015
What is Exenatide extended release?
a glucagon like peptide-1 analogue
GPL-1 are incretins - GI hormones released in reponse to food intake that increa glucose dependant insulin secretion and stimulate pancreatic B-cell proliferation.
Riederer JVIM 2016
When should exenatide extended release be used and what is the benefit of this?
safe in diabetic cats
- doesn’t cause weight gain
may assist inachieving remission (40%) or good metabolic control (90%) compared to insulin alone (20%/60%)
Riederer JVIM 2016
Which cats in the UK are at higher risk of Dm?
Tonkinese norwegian forest cat burmese >4kg >6years insured not sex
O’Neill JVIM 2016
What are environmental risk factors for DM cats in sweden?
indoors
overweight
- greedy
if normal weight, then increased risk with dry food diet.
Ohlund JVIM 2017
What changes in insulin like grwoth factor 1 can be seen with insulin therapy in newly diagnosed DM cats?
Increased IGF-1 2-4 weeks after starting insulin treatment
Strage JVIM 2017
What other factors may be prognostic markers for the likihood of a cat going into DM remission?
IGF-1 increse at 2-4 weeks after starting treatment
Strage JVIm 2017
What is increased IGF reliant on?
Available ternary complexes. increase with IFG-1 in DM remission in cats.
Strage JVIM 2017
Which cats are most at risk for posthypoglycaemic hyperglycaemia?
- 25% of diabetic cats with:
- poor glycaemic control including
- higher daily insulin dose
- higher fructosamine
- larger glycaemic variability
remission was less frequent in these cats
Zini JVIM 2017
What CT finds are noted in the pancreas of DM cats compared to normal?
- larger
- higher panc volume
- higher volume to bodyweight ratio
- shorter time to peak portal enhancement
Secrest JVIM 2018
What is pasireotide?
a multireceptor ligand stomatostatin analog
Scudder JVIM 2015
What effects does pasireotide have and when should it be used?
- decreased IGF-1 rapidly in cats with hyperstomatotrophism => increased insulin sensitivity and subsequently redued insulin requirements over 5 days.
- inhibits stomattroph growth and induce apoptosis
- inhib vac endotherlial growth factor and vasc endothelial prolif in pituitary tumours.
- used in cat swith hyperstomatotrophism/acromegaly
Scudder JVIM 2015
What changes in serum Ghrelin are expected to be seen in:
- cats with DM
- Cats with DM and acromegaly
- Cats with DM and acromegaly treated with radition therapy (post-op)
DM and DM+ acromegaly - lower than normal
Ghrelin increased after RT back to more normal range.
Jensen JVIM 2015
Why is growth hormone concentrations not used for the diagnosis of hyperstomatotrophism?
- pulsetile nature
- absence of easily accessible commercial GH assay
Keyte JVIm 2016
What is the N-Terminal Type III Procollagen Propeptide a biomarker of? What condition is it increased in?
PIIINP is a biomarker of soft issue proliferation
increased with hyperstomatotrophism
Keyte JVIm 2016
What is the sensitivity and specificity of PIIINP to differentiate between cats with DM and cats with DM secondary to hyperstomatotrophism?
Sens 87%
Spec 100%
Keyte JVIm 2016
What changes may be seen in PIIINP and IGF-1 after radiation therapy or hypophsectomy in cats with hyperstomatotrophism?
RT - increased PIINP, no change in IGF1
Hypophysectomy - decreased PIIINP and decreased IGF-1.
Keyte JVIm 2016
what causes of hyperstomatotrophism can be falsely negative on MRI/advanced imaging of the brain?
- microadenoma
- acidiphilic hyperplasia
Keyte JVIm 2016
What are the limitations of IGF-1 testing for the diagnosis of hyperstomatotrophism in cats?
- non-acromegalic diabetic cats can have increased IFG-1 (false positive)
- newly diagnosed acromegalic diabetic cats can have normal IGF-1 (false neg)
What hormone replacement is given to cats post hypophysectomy?
- hydrocortisome
- levothyroxine
- tapered dose of ADH /desmopressin acetate
+- insulin if appropriate
Keyte JVIm 2016
what does pasireotide long acting formula improve/change in cats with DM and hyperstomatotrophism?
- reduced IGF-1, insulin dose and median insulin resistive index
- no change with fructosmine or median blood glucose
Gostelow JVIm 2017
what adverse effects can be seen with long acting pasireotide?
Diarrhoea
hypoglycaemia
worsening polyphagia
Gostelow JVIM 2017
What is the median survival time for cats with hyperstomatotrophism that under go stereotactic radiation therapy?
1072 days
Wormhoudt JVIM 2017
what percentage of cats undergoing SR for acromegaly had a:
- decrease in insulin requirement?
- achieved diabetic remission?
- had permanent diabetic remission?
- decrease in insulin requirement? 95%
- achieved diabetic remission? 32%
- had permanent diabetic remission? 62% of the 32%
Wormhoudt JVIM 2017
what additional hormone supplement did cats undergoing SR for acromegaly require? and what percentage needed this?
Hypothyroid - 14%
Wormhoudt JVIM 2017
In what percentage of cats does serum TT4 normalize when fed an iodine restricted diet?
42% at 21-60 days and 83% by 180d
HUI JVIM 2015
What clinical signs did not improve during by feeding an iodine restricted diet to cats with hyperT4?
- Body weight
- heart rate
Hui JVIM 2015
What impact does iodine restricted diets have on iodine uptake by the thyroid gland in cats with hyperT4?
causes increased uptake between 38-639% from previously
Scott Moncrieff JVIM 2015
What is the prevalence of concurrent disease detected by abdominal ultrasound in cats referred for I131 therapy for hyperT4? what diseases? what percentage were not treated due to concurrent disease further investigation?
- 1% had concurrent disease
- 8% had renal disease
- 4% had neoplasia
only 2.2% were not treated as a result of findings
Nusshaum JVIM 2015
What percentage of cats being treated for hyperT4 with methimazole are iatrogenically hypothyoid?
Of these what percentage had increased creatinine?
20%
39% had increased creat
Aldridge JVIM 2015
Is fT4 superior to TT4 to detect potential iatrogenic hypothyroidism in cats with hyperthyroidism treated with methimazole?
no
Aldridge JVIM 2015
Is hypocobalaminaemia a common finding in cats with hyperthryoidism and no GIT signs?
No - prevalence is low with only 13% had it
Geesaman JVIM 2016
What are the benefits of low dose over standard dose I131 for cats with mild to moderate hyperthyroidism?
less likely to have hypothyroidism
equal likely to have azotaemia but standard dose had higher creat and higher % increase in creat compared to standard.
Lucy JVIM 2017
What is the success rate of low dose I131 compared to standard dose?
both approx 95% success.
Lucy JVIM 2017
What changes in renal blood flow are noted in cats after I131 therapy?
lower cortical and lower medullary blood velocity
lower medullary blood volume
Stock JVIm 2017
Does the use of recombinant human TSH increase thyroidal uptake of iodine in hyperhtyroid cats?
No
Oberstadt JVIM 2018
In hyperthyroid cats does SDMA correlate well with GFR?
Can SDMA resolve after treatment for hyperthyroidism?
Does nto correlate well with GFR
may resolve after treatment
Buresova JVIM 2019
what percentage of cats undergoing thyroidectomy have
- persistent or recurrent hyperthyroidism in the following 6 months?
- hypothyroidism?
22% hyperthyroids
50% hypothyroid
Covey JVIM 2018
What percentage of cats with hyperT4 have a palpable thyroid gland?
does having a larger thyroid gland correlate with higher TT4?
80% had a palpable thyroid gland
larger glands do not correlated with increased TT4
What is the sensitivity and specificity of TSH measurement to detect hyperthyroidism:
- on its own?
- in combination with TT4 or fT4?
TSH
Sens: 98%
Spec 70%
TSH + TT4/fT4
sens 97%
Spec 98.8%
Peterson JVIM 2015
What proportion of hyperthryoid cats have a detectable TSH?
2%
Peterson JVIM 2015
What percentage of hyperthyroid cats that achieve euthyroidism post treatment:
- are thin/emaciated at diagnosis
- have lost muscle condistion at diagnosis
- gain weight after treatment
- have persistence of muscle wastage post treatment?
Thin - 35%
Lost muscle mass 75%
increase weight/BCS - 100%
persistence of muscle wastage - 45%
Peterson JVIM 2016
What breeds of cat have a lower risk of hyperthyroidism in the UK?
- Burmese
- Tonkinese
- Person
- Siamese
- Abyssinian
- British shorthair
Crossley JVIM 2017
What types of cats have a higher risk of developing hyperthryoidism (UK pop)?
Long haired, non-purbred cats
Crossley JVIm 2017
what proportion of cats with thyroid cysts are hyperthyroid?
93%
Miller JVIM 2017
What were the clinical finds and % noted in cats with thyroid cysts?
- palpable neck mass - 100%
- weight loss 38%
- dysphagia 20%
- reduced appetite 13%
- dysponea 10%
Miller JVIM 2017
What proprotion of cats with hyperthyroidism had resolutation of the
- hyperthyroidism
- thyroid cyst
With I131 therapy?
Hyperthryoidism resolved in 92%
thyroid cysts resolved in 50% with small cysts <8cm3 resolving in 62% of cases and large cysts (>8cm3) resolving in 36% of cases
Miller JVIM 2017
What is a complication of bilateral thyroidectomy for treatment of thyroid cysts?
euthanasia secondary to hypocalcaemia
Miller JVIM 2017
what are findings associated with spontaneous hypothyroidism in cats?
- physical
- biochem
Physical:
- hair-coat change
- lethargy
- obesity
- palpable thyroid nodule - most common
Biochem:
- azotaemia
- 6/7 had low TT4 and fT4
- high TSH
Scintigraphy
- bilateral intense uptake with no visible thyroid tissue
Peterson JVIM 2017
What abnormalitis resolve with treatement of spontaneous hypothyroidism in cats with levothyroxine?
- azotaemia resolves
- TT4 and fT4 increase
- TSH normalizes
- reduction in goitre size from pre-treatment.
Peterson JVIM 2017
What does the MC4R gene code for and what do mutations in this affect in cats?
MC4R - melanocortin-4- receptor
- a transmembrane G-protein coupled receptor in the hypothalamaus
- roe in regulating energy balance and appetite
In cats associated with DM due to dimished glycaemic control in the presence of insulin resistance.
Hamper VCNA 2016
Which are the proinflammatory adiponectins?
- leptin
- TNF - alpha
- IL-6
- resistin
Hamper VCNA 2016
which neutriceuticals may assist with weight loss in
- dogs
- cats?
Dogs
- soy isoflavones: increased fat loss and increased likelihood of reaching target weight
- DAGs (diaclglycerols) - enhance fat oxidation => weight loss and lower serum triglycerides
Low glycaemic index starch: hydrolysed more slowly => more consistent glucose and more weight loss noted
Cats:
- Isoflavones
- Carnitine in obese cats.
Hamper VCNA 2016
Canine adipose tissue produces which adipokines associated with inflammation?
- adiponectin
- TNF- alpha
- leptin
- IL-6
- haptoglobin
- monocyte chemoattractant protein - 1
- nerve growth factor
Hamper VCNA 2016
What does the PPARG modulate?
PPARG = peroxisome proliferateor- activated receptor gamma
- expression of genese for glucose and lipid metabolis including
- GLUT4
- lipoprotein lipase
- leptin
- adiponectin
Hamper VCNA 2016
Does supplementation with short chain fructo-oligosaccharides decrease or increase insulin resistance?
decrease
Hamper VCNA 2016
What are uncoupling proteins and what is their role in the body?
uncoupling proteins:
- mitochondrial carrier protesinthat regulate protein leak to diver free energy from ATP synthesis to the production of heat
- regulate whole body energy balance
- dysfunction may lead to obesity
Hamper VCNA 2016
between obese and lean cats, what differences of LPL expression are noted?
obese cats have
- reduced plasma lipoprotein lipase
- reduced LPL mRNA in SC fat
- increased LPL mRNA in skeletal muscle
- increased HSL mRNA in skeletal muscle
Hamper VCNA 2016
what changes may be seen in the microbiome of obese dogs compared to healthy dogs?
- reduced bacterial diversity
- increased actinobacteria or peoteobacteria
- higher proportion of pseudomonadales
Hamper VCNA 2016
what are the benefits of a high insoluble fiber diet?
- lower calorie density allows increased vol of food ingested
Linder VCNA 2016
what is the benefit of a diet high in fermentable fibres?
increased fermentable fibre => increased short chain fatty acids
=> increased concentration of saitey inducing GI hormones , peripheral peptide tyrosine-tyrosine and glucagonlike peptide 1.
Linder VCNA 2016
